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Abstract

Gender bias has implications in the treatment of both male and female patients and it is important to take into consideration in most fields of medical research, clinical practice and education. Gender blindness and stereotyped preconceptions about men and women are identified as key causes to gender bias. However, exaggeration of observed sex and gender differences can also lead to bias. This article will examine the phenomenon of gender bias in medicine, present useful concepts and models for the understanding of bias, and outline areas of interest for further research.
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... 457). women as pathological (Hamberg, 2008;Rogers & Ballantyne, 2008). Thus, Morgan argues that pathologising ugliness based on gendered aesthetics results in what she refers to the "double pathologisation of women's bodies" (2009, p. 60). ...
... Chapter 6 ▪ 191 Osteoporosis, for example, can affect men and women, but the risk is higher among women than men (Ettinger et al., 1999). However, medicine is inconsistent in its own understanding of what should be ascribed to sex or to gender (Hamberg, 2008;Springer et al., 2012). According to Hamberg (2008), the confusion may be due to the substantial overlap between the biological and social aspects of sexuality in the explanation of a patient's medical problem. ...
... However, medicine is inconsistent in its own understanding of what should be ascribed to sex or to gender (Hamberg, 2008;Springer et al., 2012). According to Hamberg (2008), the confusion may be due to the substantial overlap between the biological and social aspects of sexuality in the explanation of a patient's medical problem. For example, risk of bone disease can be both due to sex-determined factors related to hormonal production (testosterone versus oestrogen), or gender-related factors that determine levels and types of physical activity. ...
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My dissertation critically examines the practice of pathologising ugliness in cosmetic surgery. ‘Pathologising ugliness’ refers to the use of disease language and medical processes to foster and support the claim that undesirable features are pathological conditions requiring medical or surgical intervention. The first four chapters offer a conceptual analysis of the conflation of health and aesthetic norms that potentially contributes to pathologising ugliness. The conceptual analysis is based on competing philosophical accounts of health, disease, beauty and ugliness. The final two chapters offer a critique of the practice by using Daniel Callahan’s goals of medicine as an ethical framework. I argue that aesthetic judgments, which underpin the pathologisation of ugliness, fail at establishing robust processes of disease determination, standard diagnostic evaluation and legitimate clinical indications. Furthermore, I contend that the practice of pathologising ugliness, which relies on prejudicial standards of beauty, legitimises oppressive attitudes based on sex, race and disability. Thus, my analysis shows that pathologising ugliness raises ethical conflicts that ultimately undermine the goals of medicine.
... In this regard, the debate is extremely heterogeneous in both terms and concepts, and several models have been proposed to account for the different types of gender biases in medicine (Ruiz and Verbrugge, 1997;Risberg et al., 2009) 1 . A way to efficiently disentangle the scholarship is to distinguish -by adapting the models of Ruiz and Verbrugge (1997) and Risberg and colleagues (2009) in light of the blindness versus stereotyping dichotomy proposed by Hamberg (2008), Verdonk and colleagues (2009), and Marcum (2015) between two forms of bias: i) gender blindness, by assuming equality between women and men when there is none; that is, by assuming that diseases' risks, symptoms and progression are equal for men and women 2 ; ii) gender stereotyp- ...
... Men are treated more extensively than women with equal symptoms in a variety of diseases (Hamberg, 2008;Mauvais-Jarvis et al., 2020). At the same time, sex and gender differences in symptoms are sometimes neglected (gender blindness). ...
... Following their work,Risberg and colleagues (2009) identified two dichotomous 'axes' producing biases: sameness/difference and equity/inequity. At the same time,Hamberg (2008) listed different types of gender biases including «gender blindness» and «stereotyped preconceptions», while the term «gender stereotyping» has been used by collegues (2009) andMarcum (2015).2 The term «gender blindness» is used here in a very specific way: to describe a specific form of bias leading researchers and clinicians to ignore gender differences. ...
Article
While gender mainstreaming in research has been systematically supported at the institutional level, most especially by the European Commission through its funding schemes, less attention has been drawn to academic teaching. However, gendering education is an equally essential pillar to take care of, given that it is in universities that future researchers and scientists are currently educated and trained. Focusing on the case study of medicine, this paper aims to give an account of what a gender-blind approach to science is, and what biases it entails at different levels of biomedical practice, from knowledge production (research) to its transfer (clinical practice) and teaching (education and training). To do so, an interdisciplinary literature review – ranging from the health to the social sciences – has been undertaken with the aim of constructing a conceptual framework that could help to map and classify the various forms of sex and gender bias in medicine. A few good international practices aimed at debiasing academic curricula in medical schools will be described as well. In this regard, the efforts made in the domain of higher education remain fragmented and limited to a single country or organisation-based initiatives, while a more systematic approach should be encouraged.
... The broader literature denotes that there may be gender bias in medicine that leads to stereotypical responses to tasks and roles that can impact power, and economic and social prosperity [25]. Women GPs may frame their work identity to conform to gendered expectations despite this playing out negatively for their financial and professional status [26]. ...
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Background Worldwide, the proportion of women entering careers in medicine is increasing. To ensure diversity and capacity in the general practice (“GP”) supervision workforce, a greater understanding from the perspective of women GPs engaged in or considering the clinical supervision of trainee doctors is important. This narrative inquiry aims to explore the uptake and sustainability of supervision roles for women GPs in the Australian context. Methods Qualitative interviews with Australian women GPs were conducted between July and September 2021. Women GPs were selected to represent a range of demographics, practice contexts, and supervision experience to promote broad perspectives. Narrative analysis drew on participant perspectives, allowing emergent stories to be explored using story arcs based on the characters, settings, problems, actions, and resolutions. These stories were evaluated by a broad research team and a high level of agreement of the final narratives and counter-narratives was achieved. Results Of the 25 women who enrolled, 17 completed interviews. Six narratives emerged, including: power and control, pay, time, other life commitments, quality of supervision, and supervisor identity. These represented significant intersecting issues with the potential to impact the uptake and sustainability of supervision by women GPs. Some women GPs reported a lack of agency to make decisions about their role in supervision and were not remunerated for teaching. Uptake and sustainability of supervision was constrained by other life commitments, which could be buffered by team-sharing arrangements and a supportive practice. Although adding a burden of time atop their complex and sensitive consultations, women GPs were committed to being available to registrars and supervising at a high standard. To foster high quality supervision, women GPs were interested in up-skilling resources, building experience and harnessing support networks. Women sensed imposter syndrome when negotiating a supervisor identity, which could be managed by explicitly valuing their contribution. Conclusion The findings can inform the development of more specific resources, supports and structures to enable women GPs in Australia to uptake and sustain the supervision of trainee doctors at a level they find both acceptable and rewarding.
... 5 The exclusion of females from research trials (extending to animal research), the neglect of female bodies throughout medical pedagogy and the unconscious biases of practitioners are a few of the intersecting factors that result in worse health outcomes for female patients. [6][7][8][9][10] Liver function tests are integral to patient diagnosis and monitoring. These 'biochemical markers' include proteins made by the liver (eg, albumin), and enzymes required for metabolism (eg, aspartate aminotransferase (AST)). ...
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Machine learning models that leverage biochemical data for modelling patient trajectories are rapidly increasing, yet these algorithms are rarely scrutinised for demographic bias or their impact on health inequalities. We demonstrate a sex disparity that exists in published ILPD classifiers. In practice, the higher FNR for females would manifest as increased rates of missed diagnosis for female patients and a consequent lack of appropriate care. Our study demonstrates that evaluating biases in the initial stages of machine learning can provide insights into inequalities in current clinical practice, reveal pathophysiological differences between the male and females, and can mitigate the digitisation of inequalities into algorithmic systems. To cite: Straw I, Wu H. Investigating for bias in healthcare algorithms: a sex-stratified analysis of supervised machine learning models in liver disease prediction.
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Globally, vascular diseases are a leading cause of morbidity and mortality. Many of the most significant risk factors for vascular disease have a gendered dimension, and sex differences in vascular diseases incidence are apparent, worldwide. In this narrative review, we provide a contemporary picture of sex and gender-related determinants of vascular disease. We illustrate key factors underlying sex-specific risk stratification, consider similarities and sex differences in vascular disease risk and outcomes comparing data from the global North (i.e., developed high income countries in the Northern hemisphere and Australia) and the global South (i.e., regions outside Europe and North America), and explore the relationship between country-level gendered inequities in vascular disease risk and the United Nation’s gender inequality index. Review findings suggest that the rising incidence of vascular disease in women is partly explained by an increase in the prevalence of traditional risk factors linked to gender-related determinants such as shifting roles and relations related to the double burden of employment and caregiving responsibilities, lower educational attainment, lower socioeconomic status, and higher psychosocial stress. Social isolation partly explained the higher incidence of vascular disease in men. These patterns were found to be apparent across the global North and South. Study findings emphasize the necessity of taking into account sex differences and gender-related factors in the determination of the vascular disease risk profiles and management strategies. As we move towards the era of precision medicine, future research is needed that identifies, validates and measures gender-related determinants and risk factors in the global South.
Chapter
The healthcare sector has been an early adopter of new technologies such as artificial intelligence, nanotechnology, or genome sequencing. They are expected to improve healthcare systems and augment practitioners’ skills. The deployment of wearable sensors and healthcare trackers are empowering individuals, making them self-aware of their wellbeing but also turning them into data donors. Personal data are essential to train machine learning models used to support healthcare professionals in decision making. However, it is extremely relevant to consider the power of the (mis-)represented population in the data analyzed. Artificial intelligent systems used in precision medicine need to be robust, not only technically but also socially by tackling gender imbalance, technology access, or other issues that may affect vulnerable groups in healthcare. This chapter offers an overview on the opportunities of digital health ecosystems while highlighting some social, ethical, and technical challenges. It also provides a review of the relation of the traditional ethical principles used in health and biomedicine and those defined for the design, deployment, and use of a trustworthy AI in Europe.
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Importance: Sex differences in aortic surgery outcomes are commonly reported. However, data on ruptured abdominal aortic aneurysm (rAAA) repair outcomes in women vs men are limited. Objective: To assess differences in perioperative and long-term mortality following rAAA repair in women vs men. Design, setting, and participants: A multicenter, retrospective cohort study was conducted using the Vascular Quality Initiative database, which prospectively captures information on patients who undergo vascular surgery across 796 academic and community hospitals in North America. All patients who underwent endovascular or open rAAA repair between January 1, 2003, and December 31, 2019, were included. Outcomes were assessed up to January 1, 2020. Exposures: Patient sex. Main outcomes and measures: Demographic, clinical, and procedural characteristics were recorded, and differences between women vs men were assessed using independent t test and χ2 test. The primary outcomes were in-hospital and 8-year mortality. Associations between sex and outcomes were analyzed using univariable and multivariable logistic regression and Cox proportional hazards regression analysis. Results: A total of 1160 (21.9%) women and 4148 (78.1%) men underwent rAAA repair during the study period. There was a similar proportion of endovascular repairs in women and men (654 [56.4%] vs 2386 [57.5%]). Women were older (mean [SD] age, 75.8 [9.3] vs 71.7 [9.6] years), more likely to have chronic kidney disease (718 [61.9%] vs 2184 [52.7%]), and presented with ruptured aneurysms of smaller diameters (mean [SD] 68 [18.2] vs 78 [30.2] mm). In-hospital mortality was higher in women (34.4% vs 26.6%; odds ratio, 1.44; 95% CI, 1.25-1.66), which persisted after adjusting for demographic, clinical, and procedural characteristics (adjusted odds ratio, 1.36; 95% CI, 1.12-1.66; P = .002). Eight-year survival was lower in women (36.7% vs 49.5%; hazard ratio, 1.25; 95% CI, 1.04-1.50; P = .02), which persisted when stratified by endovascular and open repair. This survival difference existed in both the US and Canada. Variables associated with long-term mortality in women included older age and chronic kidney disease. Conclusions and relevance: Women who underwent rAAA repair had higher perioperative and 8-year mortality rates following both endovascular and open repair compared with men. Older age and higher rates of chronic kidney disease in women were associated with higher mortality rates. These findings suggest that future studies should assess the reasons for these disparities and whether opportunities exist to improve AAA care for women.
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Medical systems in general, and patient treatment decisions and outcomes in particular, can be affected by bias based on gender and other demographic elements. As language models are increasingly applied to medicine, there is a growing interest in building algorithmic fairness into processes impacting patient care. Much of the work addressing this question has focused on biases encoded in language models—statistical estimates of the relationships between concepts derived from distant reading of corpora. Building on this work, we investigate how differences in gender-specific word frequency distributions and language models interact with regards to bias. We identify and remove gendered language from two clinical-note datasets and describe a new debiasing procedure using BERT-based gender classifiers. We show minimal degradation in health condition classification tasks for low- to medium-levels of dataset bias removal via data augmentation. Finally, we compare the bias semantically encoded in the language models with the bias empirically observed in health records. This work outlines an interpretable approach for using data augmentation to identify and reduce biases in natural language processing pipelines.
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Gender awareness in medicine consists of two at-titudinal components: gender sensitivity and gender-role ideology. In this article, the development of a scale to measure these attitudes in Dutch medical students is described. After a pilot study and a feasibility study, 393 medical students in The Netherlands responded to a preliminary instrument consisting of 82 items (response rate 61.3%). Reliability and validity were established. A gender awareness scale containing a gender sensitivity subscale (14 items), and gender stereotypes towards patients (11 items) as well as towards doctors (7 items) was developed. The instrument may be used for research purposes to evaluate gender awareness raising courses.
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A n n e F a u s t o -S t e r l i n g The Bare Bones of Sex: Part 1—Sex and Gender H ere are some curious facts about bones. They can tell us about the kinds of physical labor an individual has performed over a lifetime and about sustained physical trauma. They get thinner or thicker (on average in a population) in different historical periods and in response to different colonial regimes (Molleson 1994; Larsen 1998). They can in-dicate class, race, and sex (or is it gender—wait and see). We can measure their mineral density and whether on average someone is likely to fracture a limb but not whether a particular individual with a particular density will do so. A bone may break more easily even when its mineral density remains constant (Peacock et al. 2002). 1 Culture shapes bones. For example, urban ultraorthodox Jewish ado-lescents have lowered physical activity, less exposure to sunlight, and drink less milk than their more secular counterparts. They also have greatly decreased mineral density in the vertebrae of their lower backs, that is, the lumbar vertebrae (Taha et al. 2001). Chinese women who work daily in the fields have increased bone mineral content and density. The degree of increase correlates with the amount of time spent in physical activity (Hu et al. 1994); weightlessness in space flight leads to bone loss (Skerry 2000); gymnastics training in young women ages seventeen to twenty-seven correlates with increased bone density despite bone resorption caused by total lack of menstruation (Robinson et al. 1995). Consider also some recent demographic trends: in Europe during the past thirty years, the number of vertebral fractures has increased three-to fourfold for women and more than fourfold for men (Mosekilde 2000); in some Thanks to the members of the Pembroke Seminar on Theories of Embodiment for a wonderful year of thinking about the process of body making and for their thoughtful response to an earlier draft of this essay. Credit for the title goes to Greg Downey. Thanks also to anonymous reviewers from Signs for making me sharpen some of the arguments. 1 Munro Peacock et al. write: "The pathogenesis of a fragility fracture almost always involves trauma and is not necessarily associated with reduced bone mass. Thus, fragility fracture should neither be used synonymously nor interchangeably as a phenotype for os-teoporosis" (2002, 303).
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Book
The field of gender-specific medicine examines how normal human biology and physiology differs between men and women and how the diagnosis and treatment of disease differs as a function of gender. This revealing research covers various conditions that predominantly occur in men as well conditions that predominantly occur in women. Among the areas of greatest difference are cardiovascular disease, mood disorders, the immune system, lung cancer as a consequence of smoking, osteoporosis, diabetes, obesity, and infectious diseases. The Second Edition of Principles of Gender-Specific Medicine will decrease in size from two to one volume and focus on the essentials of gender-specific medicine. In response to the market as well as many of the reviewers' suggestions, the Editor has eliminated approximately 55 chapters from the first edition to make the book more compact and more focused on the essentials of gender-specific medicine. The content will be completely updated, redundant sections and chapters will be merged with others that are more relevant to the current study of sex and gender differences in human physiology and pathophysiology. Editor has eliminated approximately 55 chapters from the first edition to make the book more compact and more focused on the essentials of gender-specific medicine. Longer bibliographies and suggested reviews/papers of particular relevance and importance will be added at the end of each section. Each author will be asked to include recent meta-analysis of data Each chapter will progress translationally from the basic science to the clinical applications of gender-specific therapies, drugs, or treatments Section on drug metabolism will be eliminated but the subject will be incorporated into each relevant chapter Section on aging will be eliminated but age will be considered as a variable in each of the separate chapters.
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RECENT evidence has raised concerns that women are disadvantaged because of inadequate attention to the research, diagnosis, and treatment of women's health care problems. In 1985, the US Public Health Service's Task Force on Women's Health Issues reported that the lack of research data on women limited understanding of women's health needs.1 One concern is that medical treatments for women are based on a male model, regardless of the fact that women may react differently to treatments than men or that some diseases manifest themselves differently in women than in men. The results of medical research on men are generalized to women without sufficient evidence of applicability to women.2-4 For example, the original research on the prophylactic value of aspirin for coronary artery disease was derived almost exclusively from research on men, yet recommendations based on this research have been directed to